- Aetna is one of the largest private insurance companies that offers Medicare Advantage plans.
- Aetna offers HMO, HMO-POS, PPO, and D-SNP plans.
- Not all of Aetna’s Medicare Advantage plans may be available in your area.
Aetna is a health insurance company based in Connecticut. It’s one of many private insurers that Medicare has approved to sell Medicare Advantage (Part C) plans.
Aetna offers a wide range of Medicare Advantage plans designed to fit multiple budgets and healthcare needs. Not every plan is available in every state, county, or even ZIP code.
Based on where you live, Aetna may offer the following types of Medicare Advantage plans:
Now we’ll take a closer look at how the four types of Aetna Medicare Advantage plans typically work.
Aetna Medicare Advantage HMO plans
With most of Aetna’s HMO plans, you’re required to choose an in-network primary care physician (PCP). You’ll have access to a specified network of doctors and hospitals that includes specialists.
You may need a referral from your PCP to see a specialist. In the case of an emergency, you’ll be able to use an out-of-network doctor, ER, or hospital. All plans include worldwide ER and urgent care coverage.
Aetna Medicare Advantage HMO-POS plans
HMO-POS plans are HMOs that include an out-of-network option. Plan members may access medical treatment outside their HMO network for specific treatments or under special circumstances. With an Aetna HMO-POS plan, you’ll typically pay more to see an out-of-network doctor.
Aetna HMO-POS plans also require you to choose a PCP. Some will require specialist referrals from your PCP as well.
Aetna Medicare Advantage PPO plans
Aetna PPO plans let you use any doctor, in and out of network, provided that they accept Medicare and Aetna’s plan terms. Seeing an out-of-network provider will typically cost more.
You’re not required to choose a PCP and don’t need referrals to see specialists.
Aetna Medicare Advantage D-SNPs
D-SNPs are designed for people who are eligible for both Medicare and Medicaid. This is known as being “dual eligible.”
These plans offer the most comprehensive benefits for people with the highest need. Most of these plans include access to a personalized care team.
In 2021, Aetna offers D-SNPs in 23 states:
- New Jersey
- New York
- North Carolina
- West Virginia
All of Aetna’s Medicare Advantage plans include prescription drug coverage and offer a mail-order prescription drug benefit. You’ll also get an over-the-counter medication benefit that will provide free access to many products.
The Medicare Advantage marketplace is getting more competitive each year. There may be dozens of different plans to choose from in the area where you live.
The following are some examples of the costs you may see with Aetna’s Medicare Advantage plans in different areas of the country in 2021.
|City/plan||Star rating||Monthly premium||Health deductible; drug deductible||Out-of-pocket max||PCP visit||Specialist visit|
|Reno, NV: Aetna Medicare Platinum Plan (HMO)||3.5||$0||$0; $100||$7,550 in network||$0||$45|
|Bothell, WA: Aetna Medicare Select Plan (PPO)||4||$99||$0; $0||$7,000 in network; $10,800 out of network||$0 copay in network; 40% coinsurance out of network||$40 copay in network; 40% coinsurance out of network|
|Wichita, KS: Aetna Medicare Assure (HMO D-SNP)||not yet available||$0||$0; $220||$7,550 in network||$0||$0|
|Miami, FL: Aetna Medicare Credit (HMO)||4||$0||$0; $0||$3,450 in network||$0||$35|
|Staten Island, NY: Aetna Medicare Elite Plan (PPO)||4||$0||$1,000; $250||$7,550 in network; $11,300 out of network||$10||$45|
It’s important to know that these costs don’t include your monthly Part B premium, which you’ll have to pay in addition to your Part C plan costs.
By entering your ZIP code into Medicare’s plan finder tool, you can compare the various plans available in your area.
To be eligible to purchase a Medicare Advantage plan, you must be eligible for — and enrolled in — original Medicare (parts A and B).
Since not every plan is available in all locations, you must also live where the plan you want is offered.
In 2021, people with end stage renal disease (ESRD) are eligible to enroll in a broader range of Medicare Advantage plans, due to a law passed by Congress. Before this law, most plans wouldn’t accept you or would limit you to a Chronic Condition SNP (C-SNP) if you had a diagnosis of ESRD.
Deadlines for enrolling in or changing your Medicare Advantage coverage
There are several times when you can enroll in or change your Part C coverage:
- Initial enrollment: a 7-month period that starts 3 months before you turn age 65 and ends 3 months after your birth month
- General enrollment: January 1 through March 31
- Part D enrollment/Medicare add-ons: a 3-month window between April 1 and June 30 when you can enroll in a Part D drug plan or switch to a Medicare Advantage plan
- Open enrollment: October 15 through December 7
- Special enrollment: 8-month period to change your coverage, triggered by life events that cause changes to or loss of your current health coverage
Medicare Advantage (Part C) plans cover at least as much as original Medicare (Part A and Part B) plans do. They’re popular because they usually provide extras, such as dental, vision, and hearing coverage.
Some Part C plans include prescription coverage as well, so that you don’t have to opt into a separate Medicare Part D plan.
Not every plan is available everywhere. Your state, county, and ZIP code will determine which plans you can join. The costs for each plan vary by location as well. There’s a wide range of Part C plans that accommodate a wide range of budgets.
- Aetna offers many Medicare Advantage (Part C) plan options, including HMO, HMO-POS, PPO, and D-SNP.
- Plans vary by cost and offerings in different states, counties, or even ZIP codes.
- You must be eligible for original Medicare to join a Medicare Part C plan.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
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